Hospitals and exchanges need each other

Last week, the health insurance exchanges opened to strong consumer interest, not to mention some frustrating technical glitches, and saw millions of consumers checking out the new online marketplaces.

But what about providers? Have hospitals and practices welcomed exchanges with open arms? It looks like they're throwing rotten tomatoes at the exchanges, instead, giving negative feedback and even filing lawsuits. For example, Seattle Children's Hospital has sued Washington state's Office of the Insurance Commissioner for being cut out of the new exchange.

Hospitals have been pushing back after being excluded from exchange plans built around limited networks, issuing advertisements and public statements airing their complaints. Chief among those complaints: They say insurers are playing hardball with providers by offering them lower reimbursements for inclusion in their exchange networks. As a result of such negotiations, several New York hospitals opted out of some exchange plans, WNYC News reported.

Many physician practices are taking a cautious approach to exchanges. They remain unwilling to commit to contracts due to lingering questions over certification, deductibles and the number of covered patients.

Such unknowns have led hospital administrators to worry that exchange payments won't offset Medicare reimbursement cuts under the Affordable Care Act. "Obviously, there's some concerns with the [health insurance] exchange with this being new to everyone," B.J. Roberts, assistant vice president of fiscal services at White County Medical Center told Arkansas Business.

The exchanges are still a work in progress but exchanges and hospitals need to play on the same team for both groups to succeed. That's because hospitals are key to getting consumers enrolled in the plans, and exchanges will provide hospitals with additional insured patients who can pay their bills.

The University of Arkansas for Medical Sciences (UAMS), for instance, recognized the opportunity for exchange participation to increase its insured patient ranks and therefore improve its bottom line.

"Thirteen percent of our business today is uninsured," UMAS Medical Center CEO Roxane Townsend told Arkansas Business. "If we are able to get 75 percent of those people enrolled in the insurance exchange over a six-month period, it could mean an $8 million gain for the medical center at UAMS."

Despite the unknowns surrounding the new marketplaces as they continue to works out kinks, hospitals should consider the potential windfall from a wave of exchange patients.

"On the plus side, we are going to have a whole segment of our population that will have insurance. That's got to be a positive," Gary Bebow, the CEO of the White River Health System in Batesville, Ariz., told the publication.

How has your hospital responded to the exchanges opening for enrollment? Should hospitals join the exchange team to get patients enrolled in coverage via the new marketplaces? - Alicia (@FierceHealth)

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